Healthcare Provider Details

I. General information

NPI: 1528373248
Provider Name (Legal Business Name): CHARLOTTE VALDEZ CERTIFIED NUTRITION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 SALAZAR ST
SANTA FE NM
87505-1044
US

IV. Provider business mailing address

612 SALAZAR ST
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-699-6712
  • Fax: 505-820-9374
Mailing address:
  • Phone: 505-699-6712
  • Fax: 505-820-9374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberCERTIFICATION
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: